Nicolau-Raducu Ramona, Occhipinti Elise, Marshall Thomas, Koveleskie Joseph, Ganier Donald, Evans Brian, Daly William, Fish Brian, Cohen Ari J, Reichman Trevor W, Bruce David, Bohorquez Humberto, Seal John, Ahmed Emily, Carmody Ian, Loss George, Rayburn Jonathan, Nossaman Bobby
Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
Department of Hematology, Ochsner Clinic Foundation, New Orleans, LA.
J Cardiothorac Vasc Anesth. 2017 Apr;31(2):575-581. doi: 10.1053/j.jvca.2016.08.001. Epub 2016 Aug 2.
The purpose of this study was to compare the agreement between two heparin assays, Hepcon HMS plus/Kaolin-ACT and Anti-Xa, and their predictive power in detecting circulating heparin levels post-reperfusion of the liver graft when compared with thromboelastogram (TEG) r time ratio in patients undergoing orthotopic liver transplantation (OLT).
Prospective, observational cohort study design.
Single center, university hospital.
Thirty-eight consecutive adults who had undergone liver transplant.
None.
Paired arterial blood samples were collected before surgical incision, 5 minutes after administration of an average dose of 2,054±771 units of intravenous unfractionated heparin before caval cross-clamping, 5 minutes after portal reperfusion, 5 minutes after hepatic artery reperfusion, and 1 hour after hepatic artery reperfusion. The observations that heparin assay measurements were within the predetermined limits of agreement, strongly suggested the two heparin assays (Hepcon HMS plus and Anti-Xa assay) are interchangeable during prophylactic heparin dose therapy during OLT. Post-reperfusion, receiver operating characteristic curve analysis revealed high accuracy in measuring circulating heparin levels with both Anti-Xa and Hepcon HMS assays when compared with the TEG r time ratio assay.
The point-of-care Hepcon HMS plus/Kaolin-ACT (activated clotting time) assay appeared to be a reliable alternative to the more expensive and laboratory-required Anti-Xa assay in monitoring the response to intravenous heparin in patients undergoing OLT.
本研究旨在比较两种肝素检测方法（Hepcon HMS plus/高岭土活化凝血时间[Kaolin-ACT]和抗Xa因子检测）之间的一致性，以及与原位肝移植（OLT）患者血栓弹力图（TEG）r时间比值相比，它们在检测肝移植再灌注后循环肝素水平方面的预测能力。
前瞻性观察队列研究设计。
单中心大学医院。
38例连续接受肝移植的成年人。
无。
在手术切口前、腔静脉阻断前平均给予2054±771单位静脉普通肝素后5分钟、门静脉再灌注后5分钟、肝动脉再灌注后5分钟以及肝动脉再灌注后1小时采集配对动脉血样本。肝素检测测量值在预定一致性范围内的观察结果强烈表明，在OLT预防性肝素剂量治疗期间，两种肝素检测方法（Hepcon HMS plus和抗Xa因子检测）可相互替代。再灌注后，受试者工作特征曲线分析显示，与TEG r时间比值检测相比，抗Xa因子检测和Hepcon HMS检测在测量循环肝素水平方面具有较高的准确性。
在监测OLT患者静脉肝素反应方面，即时检测的Hepcon HMS plus/高岭土活化凝血时间检测似乎是更昂贵且需要实验室检测的抗Xa因子检测的可靠替代方法。
